Stomach surgery: the first step

Last night I attended Canberra Bariatric’s information night, held at their office within John James Hospital.

Presented by Doctor Sivakumar Gananadha, one of the two surgeons who run the centre, the information night is designed to provide an overview of the gastric surgery procedures and to walk prospective patients through the process of having surgery on your stomach.

I entered the room at 5pm on the dot and found it quite full; there was probably about 25-30 people in the small waiting area. I took my seat and had a look around. It was nice to be in a room full of people like me – it was reassuring to see a wide variety of people of different backgrounds, young and old, some bigger than I, some smaller.

Dr Gananadha welcomed us to the session and then gave a basic overview of obesity stats – but acknowledged that most of us had probably heard all this before. He was very open in his manner of speak, and also realistic in noting that we were all there because things like diet and exercise didn’t work for us.

A slideshow played behind Dr Gananadha, and he went through the three procedures available for weight loss surgery:

The Gastric Band – a band is placed around the top of the stomach, to section off (but not remove) the large part of the stomach. This procedure can be reversed.

The Gastric Sleeve – the stomach is cut and most is removed, leaving behind a small pocket of stomach that is stapled together. This procedure is permanent.

The Gastric Bypass – food bypasses the stomach all together and is diverted down to the small bowl, meaning that the gastric juices are unable to absorb calories from the food. The procedure is permanent.

Each option was explain in detail, with pictures and computer animated videos to show how the procedure is done. Doctor Gananadha also provided pros and cons for each option – the band is the least invasive but requires the most work from the patient (easily stretched, things can get stuck); the sleeve is permanent and you will get sick if you eat even a bite too much; the gastric bypass is quite an invasive surgery and the Doctor did not recommend it as the risks outweight the benefits (also no doctor in Canberra actually does this surgery, you’d have to go to Sydney).

While the doctor was speaking, I made up my mind which option I want to go with – the gastric sleeve. The gastric sleeve seemed like the best option of the three by far, and I get the impression that Doctor Gananadha thought so too – which is encouraging.

The gastric sleeve is done by keyhole surgery, removing over 80% of your stomach – the average stomach can hold 1-1.5 litres of food, after the surgery you can hold 150-200ml. The desired amount of stomach is sectioned off and what remains is closed up and stapled to look like a tube (or sleeve).

Your stomach will look like a banana!

Weight loss is achieved by restricting your portion sizes and by removing a part of the stomach that produces Ghrelin, a hormone that signals hunger in the brain. By removing Ghrelin, the brain doesn’t feel hunger and this results in the patient not wanting to eat.

The sleeve requires less follow up than the band, and the risks involved are fairly minimum – possible leaking through the staples and stretching by eating too much.

After Doctor Gananadha spoke, Jason Levett, the centre’s resident dietician spoke to us about our food intake before and after the surgery. As part of your initial consult, and aftercare, you are required to see Jason to ensure you are eating the right food for your new stomach.

For the sleeve, you can eat 3-5 small meals a day (depending on calorie use) of around ½ to ¾ of a cup and you cannot eat and drink at the same time. Jason also had a great point when he said that you need to work with your new stomach to achieve weight loss – if you eat nothing but high calorie foods, then you’re not going to see results. He had some great anecdotes about people who have done stupid things after surgery – one lady at KFC two days after and it got stuck at the top of her band and ruined it, which meant her entire surgery (and the $8,500 she would have spent) were a waste of time. I liked his analogy of the weight loss being like personal trainer – it’s a tool, but if you don’t use it properly than there’s no point wasting your money.

Jason told us what we can expect food wise before the surgery – generally a minimum of two weeks on Optifast to shrink the liver – and after:

(2) Fluids for 2 weeks after the surgery – including soups, juice, coffee, tea and milk.

(2) Soft to regular foods over a two week transition period – soft or tinned fruit, minced meat, cooked vegies, eggs, soft breakfast cereals, and then after two weeks you can try solid foods and see how they react.

The entire process is at least 10 weeks, with 8 of those after the surgery itself. It’s a slow process, and you should lose a tonne of weight in those two months, but you have to make sure you’re input has a high nutritional value.

We ended the night with questions, of which I had none – they’d answered everything I wanted to know. One attendee asked about cost, to which Dr Gananadha replied that the clinics fee was about $6,000 and then the anaesthetist charged an extra fee (which he did not know, but I believe it’s around $1,500) and it was usually around $1,000 per night for the hospital – which would equal $10,500 for a three night stay (but it is advised to “prepare for the worst” and have a few thousand up your sleeve for any extra nights that may be needed). You’ll get a little bit of money back on Medicare and your private health, but it seems that the general out-of-pocket is around $5,000 to $7,800 – I do know a lady who paid $20,000 although I’m still unsure as to how that happened.

I would highly recommend going to an information session if you’re considering getting gastric surgery in Canberra – it’s a good over view and it will help you make the decisions you need to before you make an appointment with a surgeon. The sessions run one or two times a month, just call Canberra Bariatric and speak to Sue (their lovely receptionist) about dates.

Doesn’t sound like you get very much – I would only do it if the sleeve failed. It bypasses the part that takes in calories, yes – but it also bypasses the part that takes in nutriants. I expect that people who have the bypass done won’t be able to do exercise and they would probably have to have vitamin injections (rather than tablets, because they are broken down in the stomach juices).